内科住院医师规范化培训项目制的实践与探讨

Introduction and discussion on the practice of standardized residency training program in internal medicine

毕业后医学教育是培养临床医师的重要环节。由于胜任力医学教育的复杂性以及临床繁重的工作压力影响教学,促使美国的教学医院设立了专门负责住院医师规范化培训(住培)的管理的制度-住院医师培训项目制。浙江大学医学院附属邵逸夫医院内科于2011年从美国罗马琳达大学率先引入住培项目制。内科住培项目制是相对独立运作与管理的培训体系。培训项目由内科项目主任负责,并组建核心师资团队开展管理。核心师资主要有内科各亚专科教学协调员、助理项目主任、住院总医师等组成,在项目主任的领导下开展对内科住院医师的教学、临床实践、考核与评估,以及对师资进行管理并开展培训。住培项目制管理实现了临床与教学的衔接,完善了教学医院中毕业后教育架构。拥有教学热情的临床师资利用项目制来实现专业化的医学教育。项目制中的核心师资起到临床与教学的桥梁作用,保证了培训计划的实施。住培项目制营造了临床师资中的教学氛围,有利于医学教育事业的传承,体现了临床教学管理的新格局。

The graduate medical education(GME)is the key point of training physicians.Residency training programs were set up in American teaching hospitals for specialized accountability to train residents due to the complexity of competency-based medical education(CBME)framework,as well as busier clinical work.The internal medicine residency training program was established in Sir Run Run Shaw Hospital in 2011,which was firstly introduced by medical educators from Loma Linda University Medical Center.The program has been designed as a relatively independent system of teaching and management,and is overseen by the residency program is director(PD)who is also supposed to nominate a group of core faculty to implement teaching and assessment plans.The core faculty are composited of sub-specialty educational coordinators(SECs),assistant program director(APD),and chief residents.The program under the leadership of PD who is in charge of training residents,arranging clinical rotation,assessing and evaluating the performance of the trainees,and providing clinical faculty development and management as well.The internal medicine residency program acts as a joint role between clinical practice and education,building up a complete educational framework of GME.The enthusiastic clinical teachers also can provide professional medical education through the program.The core faculty are the combination of physicians and educators who can guarantee the implementation of program.The program of internal medicine creates positive teaching atmosphere among the faculty,as well as passes the educational accountability transmission through generations.An education system running by the physicians,composed of the physicians,and serving for the physicians,deserves applause in new era of changing.